Anorectal varices and hemorrhoids difference

[Lothric]

Hey,

In portal hypertension, blood is shunted from the superior hemorrhoidal vein to the middle and inferior rectal veins.

However, Pathoma claims that the portosystemic shunts include hemorrhoids. Is this correct?

I mean, definition of hemorrhoids is dilated veins either above or below the dentate line. So it seems that anorectal varices just fall into this broad general category that is hemorrhoids. Can I reason this way or is this wrong?

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[USMLE_Pro]

Hemorrhoids are actually neither arteries nor veins; a hemorrhoid is better described as a sinusoid or arteriovenous plexus. We all have hemorrhoids, but only some have pathologically enlarged hemorrhoids. Increased portal pressures predispose to pathologically enlarged hemorrhoids because of increased pressure transmitted through a portosystemic shunt.

Regardless, the high yield facts from a Step 1 perspective are more about knowing the relevant anatomy (i.e. superior, medial, and inferior rectal veins and where they originate from).

 

[Lothric]

Hemorrhoids are actually neither arteries nor veins; a hemorrhoid is better described as a sinusoid or arteriovenous plexus. We all have hemorrhoids, but only some have pathologically enlarged hemorrhoids. Increased portal pressures predispose to pathologically enlarged hemorrhoids because of increased pressure transmitted through a portosystemic shunt.

Regardless, the high yield facts from a Step 1 perspective are more about knowing the relevant anatomy (i.e. superior, medial, and inferior rectal veins and where they originate from).

Thanks for your answer,

Am I wrong to say that hemorrhoids are capillaries then and that anorectal varices can be considered a form of hemorrhoids? If not, what is the connection between anorectal varices and hemorrhoids? Are they associated?

 

[USMLE_Pro]

Thanks for your answer,

Am I wrong to say that hemorrhoids are capillaries then and that anorectal varices can be considered a form of hemorrhoids? If not, what is the connection between anorectal varices and hemorrhoids? Are they associated?

Hemorrhoids are not capillaries. You should think of portal hypertension as a risk factor for pathologically enlarged hemorrhoids.

 

[Lothric]

Hemorrhoids are not capillaries. You should think of portal hypertension as a risk factor for pathologically enlarged hemorrhoids.

Thanks!

I think I understand it now: Portal hypertension can give rise to anorectal varices. Due to the more fluid in the lower body systemic venous system now, the likelihood of hemorrhoid-development is markedly increased.

Hemorrhoids can be thought as a sinusoid you said. Those are capillaries though. To be fair, you wrote "described as" and not "are". Why is this such an ambiguous term? Mayo clini says they're veins, Wiki says "vascular structures". I'll just go with vascular structures then

 

[USMLE_Pro]

Thanks!

I think I understand it now: Portal hypertension can give rise to anorectal varices. Due to the more fluid in the lower body systemic venous system now, the likelihood of hemorrhoid-development is markedly increased.

Hemorrhoids can be thought as a sinusoid you said. Those are capillaries though. To be fair, you wrote "described as" and not "are". Why is this such an ambiguous term? Mayo clini says they're veins, Wiki says "vascular structures". I'll just go with vascular structures then

Sinusoids aren't the same thing as capillaries. The best term is an AV plexus. It's also key to realize that everyone has hemorrhoids (they help with continence for gas actually!), they're a physiologic structure, but they cause problems when enlarged (so colloquially you only have hemorrhoids if you have enlarged hemorrhoids).

None of this is particularly important for you to know; I just spent 2 months on colorectal surgery and now am doing hepatology research for a year.